Hematopathology

Bone Marrow

1. Two forms of patient ID are required by the College of American Pathologists (CAP). Label the side (not the lid) of ALL primary* specimen containers and ALL slides with two (2) patient identifiers including first and full last name, date of collection, and specimen type/site (including LEFT or RIGHT if relevant) at the time of collection. Place one (1) of the peel-off labels from the Test Requisition onto each specimen container, if available. Examples of acceptable identifiers include, but are not limited to: patient name, date of birth, hospital number, social security number, requisition number, accession number, unique random number or clinical chart numbers that identify the patient. A location (e.g., hospital room number) is not an acceptable identifier. 

*Primary specimen containers are the innermost container received by the laboratory that holds the specimen. 

2. Submit one (1) peripheral blood smear if available and relevant to the diagnosis under consideration.

3. Submit at least 4–6 bone marrow smears and, when biopsy is performed, two (2) touch imprint slides. Marrow should be thinly smeared and ideally not touch the edges of the slide.  Slides must be thoroughly air dried before packaging.  The diagnostic yield of thick smears and smears that are not properly dried is greatly decreased.  Smears and touch imprint slides should be submitted in tightly wrapped plastic containers, bags, and/or cardboard holders. Always separate them from formalin-fixed specimens. Unstained smears exposed to the slightest trace of formalin vapor will not stain properly.

4. Submit the bone marrow clot in formalin. Make sure the clot has formed before putting it in formalin. Label as “Clot” and add LEFT or RIGHT, if applicable.

5. Submit the bone marrow core in formalin. Label as “Core” and add LEFT or RIGHT, if applicable.

6. For flow cytometry, submit:

·         3 mL of bone marrow aspirate in a sodium heparin (green) tube (PREFERRED) or EDTA (lavender) tube

·         If bone marrow aspirate is not available (dry tap), a SECOND/SEPARATE bone marrow core biopsy in RPMI or equivalent transport media is acceptable

·         If bone marrow aspirate is not available (dry tap), 5 mL peripheral blood in a sodium heparin (green) tube (PREFERRED) or EDTA (lavender) tube

7. For chromosome analysis (classical cytogenetics), FISH studies, or Microarray submit:

·         3 mL of bone marrow aspirate in a sodium heparin (green) tube (the MANDATORY tube type for Cytogenetics)

·         If bone marrow aspirate is not available (dry tap), 5 mL peripheral blood in a sodium heparin (green) tube (the MANDATORY tube type for Cytogenetics).

8. For molecular studies, submit 1 mL of bone marrow aspirate or, if aspirate is unavailable, 3-6 mL of peripheral blood in a lavender (EDTA) tube. Consultation with a Quest Diagnostics Genetics Counselor at 1.866.GENE.INFO (1.866.436.3463) is recommended before acquiring specimens for molecular testing.

Complete a Hematopathology Test Requisition, including: 

• Patient’s full first and last name 
• Date of birth
• Submitting physician’s name, NPI number, and telephone number 
• Date of collection 
• Source of specimen 
• Clinical history including the most recent office note
• Most recent CBC including differential

** Specimen Collection kits are available upon request.

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